Summary MVU NURS 629 Exam Final Exam Study Guide | Latest Update (Rated 100%) 2023/2024

MVU NURS 629 Exam Final Exam Study Guide | Latest Update (Rated 100%) 2023/2024. What are the recommended office visits (interval) for a low-risk client throughout the pregnancy? ○ What is the recommended office visit interval during each trimester? 1. Up to 28 weeks – Every 4 Weeks 2. 28 to 36 weeks – Every 2 weeks 3. 36 weeks and on – Every week or more as necessary ○ What are appropriate findings for each trimester? 1. 1 st Trimester: week 1-12 1. Breast enlargement, darkening of areola, raise pink Montgomery’s tubercles, nausea, vomiting, and fatigue. Heart tones with Doppler. Positive pregnancy test. Also audible with ultrasound around 12 weeks. Chadwicks sign, Goodell’s sign. Neural tube development for the baby, rapid cell growth. Vital systems are beginning to form. 2. 2 nd Trimester: week 13-26 1. Surge in energy levels, mother will start having an enlarged abdomen from growing fetus, fetal movement, leg cramps, varicose veins, backaches, and nasal congestion. Gender and heart tones are assessed. Heart tones present around 14 weeks. 3. 3 rd Trimester: week 27-40. 1. Linea negra, pressure on lungs, bladder may be palpable, Braxton hicks contractions, back pains. Head engages into the pelvis ○ What are the normal, non-worrisome complaints during each trimester and what complaints would need to be evaluated further? 1. 1 st Trimester: 1. Increasing tenderness and size of breasts: Changes in breast or nipple size, shape, symmetry, as these s&s may indicate other condition. 2. Constipation: Should not include change in stool, fever, weight-loss, anorexia, periumbilical pain, fever, rectal bleeding, pus, or mucous. 3. Excessive salivation (ptyalism), bad taste in mouth: Refer client with dental disease. 4. Fatigue: Refer if psychosocial stress increases. Expected in 1st and 3rd trimester 5. Flatulence: Refer to a mental health care provider if symptoms of psychosocial stress are evident. 6. Headache: If headache is severe, change in vision, severe swelling of hands and feet, if painkillers don’t respond. 7. Hemorrhoids: Rectal lesions (condyloma acuminate cancerous lesion) 8. Nausea and vomiting: Weight loss, dehydration, ketonuria, and hypokalemia. 9. Urinary frequency and incontinence: Frequently repeated UTI’s 10. Varicosities of vulva and legs: Vascular disease, deep vein thrombosis, 2. 2 nd Trimester: 1. Backache: Refer if pain does not improve 2. Dyspnea: S&S of respiratory infection, PE, cardiac problems, or anemia. 3. Epistaxis: Nasal polyps and evidence of cocaine use 4. Leukorrhea: Green, watery or bloody stools, foul or fishy smelling odor, vaginal itching or discomfort, fever, flulike sx, abdominal pain, or bleeding after intercourse, dysuria or dyspareunia. 5. Ligament pain: Anorexia, flank pain, vomiting blood, low-grade fever, diarrhea, vomiting, or a tender lump in the groin that tends to worsen. 6. Muscle cramps in calf, thigh, or buttocks: Homan’s sign, no redness, tenderness, heat or swelling should be noted. 7. Pica: If eating dangerous items consult psychologist. (sign of iron deficiency). 8. Syncope: Substance abuse, sinus, hearing, or ear problems, numbness or tingling in digits around the mouth, melena, heart palpitations, SOB, anxiety/depression, nausea, vomiting. 3. 3 rd Trimester: 1. Braxton-hicks contractions: If labor is continuous, no vaginal bleeding, if contractions begin getting closer together. 2. Discomfort in the upper extremities: Recurrent hyperventilation warrants further investigation 3. Edema: Visual changes, headache, fatigue, nausea, vomiting, abdominal pain, decreased urine output. 4. Heartburn: SOB, chest pain, hypertension, palpitations, sweating, flulike sx, right shoulder pain. 5. Insomnia: Psychosocial stress, anxiety, s&s of suicide 6. Joint pain/ache: Signs of labor, signs of tick bites, symptoms of uti, redness of joints, intermittent claudication, stiffness, flulike symptoms, fever. ○ What OCP can be given to breastfeeding women? 1. Progestin-only pill (POP) also called the “mini-pill” ○ What immunizations can be given in pregnancy? 1. Flu 2. TDAP 3. Possible Hep B 4. Chickenpox (varicella) vaccine, measles, mumps and rubella (MMR) vaccine, shingles vaccine. ○ How to screen for gestational DM (See Assessment PPT) 1. 1 hour GTT (24-28 weeks). Drink 50g of glucose. If 1 hour BG is ≥130-140 proceed below 2. 3 hour GTT high carb died x2 days, then NPO after MN. FBS, then drink 100g of glucose 3. Gest diabetes is diagnosed with 1 hour (180), 2 hour (153). 4. Two Step - If the value meets or exceeds the thresholds below and is ≤ 200 mg administer a 100-g oral glucose tolerance test. 1. 50g oral glucose challenge – 140mg after 1 hour threshold 2. 100g oral glucose test – 1 hour (180), 2 hour (155), 3 hour (140). 5. One Step 1. Administer 75 g oral glucose – 1 hour (180), 2 hour (153). At risk if over 35, overweight, previous FBS 110-125, previous gest diabetes, previous infant > 9lbs, previous unexplained stillbirth, family history of diabetes. ○ Treatment of mild PIH 1. Bed rest, lay on left side, methyldopa, labetalol. 1. Second line – verapamil nifedapine, hydralazine (bad hypertension), may use diuretics ○ s/s of mastitis 1. Subjective: Malaise, fever, chills. Also a tender, hot, red, painful area or lump in the breast. 2. Objective: Fever (often high), tachycardia. Warmth, redness and swelling of breasts. Breast distended with milk. Nipple may be cracked or abraded. ○ s/s of gestational HTN 1. Subjective: Headache, edema, weight gain, vision changes, nausea, vomiting, pain in upper right side of stomach, making small amounts of urine 2. Objective: elevated blood pressure, proteinuria, edema. ○ What should the fundal height be at various prenatal visits? 1. 6 weeks: Hegars (softening of lower uterine segment is present) 2. 12 weeks: The fundus is noted at the symphysis pubis 3. 16 weeks: the fundus is midway between the symphysis and the umbilicus 4. 20 weeks: uterine fundus can be palpated at the umbilicus and measures 20cm. 5. 36 weeks: the fundus is just below the xiphoid process and measures approximately 36cm in length. 6. ○ Positive signs of pregnancy? 1. Presumptive: amenorrhea, breast tenderness and enlargement, chadwicks’s sign, fatigue, hyperpigmentation, chloasma, linea negra, fetal movements (quickening), urinary frequency, nausea/ vomiting. 2. Probable: abdominal enlargement, ballottement, Braxton-hicks contractions, goodell’s sign, hedgar’s sign, palpitation of fetal contours, positive pregnancy test, uterine enlargement. 3. Positive: auscultation of fetal heart sounds, palpitation of fetal movements, radiological and/or ultrasonic verification of gestation ○ Fetal development during pregnancy 1. First trimester 1. During this trimester, your baby will change from a small grouping of cells to a fetus that is starting to have a baby’s features.